Travel Nursing in rural NC

[ptsfirst]

I have traveled nursed for approximately the past 5 years and for the most part it hasn't been bad. Since traveling in the southern part of NC for the past year I am both emotionally drained and literally trying to figure out how to get out of nursing.

First scenario, My first assignment was actually right alongside the NC/SC border on SC side. I was told that I would be working in ICU alone - no second nurse with an CNA (no ACLS). I refused, called my recruiter (who is awesome) and our clinical specialist backed me up. I worked out the course of my contract without incident and agreed to extend. The day before my "new" contract was to start they again told me that I would be in ICU alone. Again, I refused. They agreed to have the House Supervisor work out of ICU and they would send someone ACLS certified to be with me when she made rounds,etc. The next day I was told my contract would not be extended by my recruiter and the CNO of the facility tried to have me blackballed for the hospital system (big in SC). I fought that part of it - spoke with both Director of unit and multiple MDs who have since been references for me. This happened right before the floods in NC happened and it was 6 weeks before I could work.

Second scenario, I took a job in another moderately sized hospital in southern rural NC. During the course of this assignment I was given 3 patients almost every time I worked, 2 of which were almost always vent/drip patients. When I questioned it I was told this is the way it is here. I had already depleted my savings and credit cards due to my last experience so I struggled through and it was terrifying.

Third scenario, this one was actually good. I took an assignment in the Raliegh area and finished my assignment in ICU without incident.

Fourth scenario, took an assignment on NC/SC border - NC side this time in ICU. I was floated to every floor in the facility without warning or any orientation. By orientation I mean I wasn't walked to the unit, I wasn't introduced to anyone, I wasn't given codes for med room/carts, or oriented to what part of the computer system they used in the lesser acuity areas. I had to find all of this out myself. I was floated to PCU (no problem) but received a patient who was not stable - new onset DKA - 80 years old with bp of 70/30 - Charge nurse was there told me to call MD and left. No rapid response per her. I called the MD - who gave me orders (not good for pt with CHF - you can guess). I managed to keep her alive while taking care of 4 other patients. In the morning I texted the manager of the unit and voiced that I had some concerns and we could talk the next time I worked. We had previously had a meeting when I informed her that patients were being admitted on Levophed being run through PIVs. Low and behold - I get a call from my recruiter stating my contract was terminated. When I asked why - he was told I was yelling and cursing at the nurses station!?! Anyone who knows me knows that I would NEVER behave in such a manner. My agency performed an internal investigation and cleared me of any wrong doing. Additionally, one of the nurses from the unit told me that they had a huddle the next day - when someone asked where I was the unit manager told them that I had decided that I no longer wanted to be an ICU nurse and was going to just focus on school?!! WTH

I am again without work as it takes time to set up a travel assignment. I lined up a gig in Eureka, CA - had to wait a month but the money was going to be amazing - I paid for a $600 plane ticket (that will take 90 days to get refund) only to get a call that the hospital overbooked and cancelled my contract.

So here I sit flat broke at christmas with my elderly mother (lives with me) and I am feeling completely defeated and broken. I have gone through my entire savings and maxed my credit cards out because I do the right thing. I am now trying to get on at a hospital nearby with a horrible reputation but it is the holidays and there is no sense of urgency to hire at this time. Accept on my part of course.

Through all of this I have met so many amazing nurses who refuse to use their voices and do whatever they are told because they need their paychecks. I simply cannot put my license in or patients in jeopardy.

But here is the kick in the gut... I believe that nursing is one giant family. We work together to save lives and to improve lives for our patients. We hold each other to a professional standard. But my reality is that everything I have experienced here has been due to the complacency of another nurse. The culture of healthcare in this area is like nothing I have ever experienced and it will take me a long long time before I fully recover both financially and emotionally. Thank you for letting me vent.

[NedRN]

Sure, forums are good for venting.

Not sure I can make you feel better, but I do have some comments.

Nursing in the South sucks. Terrible ratios and they even try to get away with it in ICU! Amazing.

It could have been worse. Most hospitals in both North and South Carolina belong to the SCHA (South Carolina Hospital Association), and while I've not heard of a SCHA unified blackball list, I know of two legal ways to create such a list. One is via a vendor manager, and the other is via a credit reporting workaround - this is what the Dallas Fort Worth Hospital Association does and creates a very stressful working environment for Texas staff nurses. Some very long threads on this issue in the Texas forum.

But certainly union area hospitals in the Northeast and west coast are better to work for with a contracted staffing ratio. California takes it one step further with a state law mandating ratios per specialty and acuity. Too bad about Eureka. I liked working there. The ICU is in a new wing, four or five years old now.

So the deal, especially in the South, is that it can take just one person (even a secretary as I found out in Miami) to be annoyed by you and you are gone (at least in hospitals that don't respect contracts). Travelers are disposable commodities as you have found out, and do not have a staff "family" get-out-of-jail-free card. So travelers have to be uber professionals in many environments to finish assignments. This doesn't mean that you were not professional, but be careful about everything, from tone of voice to how you phrase facts. Someone could have been pissed off by something as simple as you were more clinically capable and experienced than they were, and felt like you were talking down to them or lecturing from a better knowledge base. A very fine line indeed.

I have been in other hospitals where they respect contracts so much, it takes a lot for them to break it, even when there is clear incompetence. I remember one OR traveler in a Massachusetts hospital who clearly had never been in a hospital OR before (she may have been in a doctor's procedure room or surgery) and it took them 4 weeks to terminate her. They did it for lying on her application, not her incompetence. Perhaps they were lawsuit averse.

Anyway, the situations you describe do not allow for contractual termination for cause. Therefore, something must be falsified and they will make something up. As it happened to you. So I've been traveling for over twenty years and as you might tell if you read other posts of mine here, I have a bit of an "edge". So I have been terminated a number of time. I once had a director of surgery terminate me (again a secretary was involved, plus a specimen label that needed adjustment) and I mentioned that he did not have contractual cause. Honestly, they didn't really need me as the open heart surgeries they were expecting never ramped up. Low census is not a contractual reason to terminate. But he told me to my face that he would make up a clinical reason if I didn't accept it. That was pretty stunning.

You hear about these situations fairly frequently on social media. It is upsetting to be fired for any reason, especially when you are doing your job competently and advocating for your patients. The resulting rants make travel seem pretty scary. Fortunately, they happen less than you might think. There is a travel industry metric that says the industry average is that 1 out of 10 assignments fails to complete for all reasons. That includes your cancelled Eureka assignment. No way to know how many of those 10% failed assignments were due to "incompetence", low census, or "fit". Safe to assume some fraction though.

In my case, indeed one out of ten assignments does have a problem in twenty years plus of travel. But again, I have an edge. So with some prudent steps, the average traveler should be able to beat the average by a significant margin. Indeed, I know twenty year travelers who have never been terminated (or don't admit to it). I know of another very competent traveler who probably has an issue with every third or fourth assignment because she is not willing to bend her very high standards in work environments with lower standards. I have a good friend, about 12 years of travel experience who is very competent, but a major skill of his is his ability to get along (more important in general than clinical ability) - and yet he was terminated once for one slip. An ED nurse, two of his patients were coding and the charge nurse wanted him to pick up a new admit and he barked at her. That was all it took.

Protecting yourself means being proactive. Not just minding your P's and Q's on an assignment with everyone you interact with, patients, family, nurses, managers, and support staff: but having a good recruiter that knows a facility well and can provide honest feedback on how readily they are willing to terminate. Asking the manager why they need you during your interview can be revealing. High census, had a run of "bad" travelers, or overworked staff, or high turnover can raise red flags (versus the optimal pregnancy leave, vacation support, or never used a traveler before).

Anyway, sorry it happened to you. Get out of the South to have more reliably good assignment.

[ptsfirst]

Just knowing this has happened to others, although terrible, is somewhat comforting. I have a lease on a house until May, then I am out and I will never look back. Thanks :-)

[NedRN]

Hey, just learned agencies are asked to resubmit for medsurg in Eureka. Notice as of 7pm EST. Call yours ASAP! Good luck!

[NedRN]

One medsurg position was filled today in Eureka. There might be one more, a little difficult for me to say with the info I have. The whole thing may have been a big game by the vendor manager (American Mobile) anyway to lower the promised bill rate. I've seen it before and that might be why the promised good pay was so high. I will say that if you like those Northern California hospitals, you will have first dibs on them if you sign up directly with American Mobile. The money may not be as good (or it could be), but a job is better than no job!